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Biomedical subjects

M Nishinaga

Publications and source records attributed to M Nishinaga.

At least 37 records · Page 2Linked to original sources

Endothelial-derived nitric oxide preserves anticoagulant heparan sulfate expression in cultured porcine aortic endothelial cells.

Nitric oxide (NO) has been shown to inhibit platelet adhesion and aggregation, but there are no reports on its interaction with the coagulation system. We investigated the effect of the L-arginine analogues, N-nitro-L-arginine (LNA), N(G)-nitro-L-arginine methyl ester (L-NAME), and N(G)-monomethyl-L arginine (L-NMMA), competitive inhibitors of NO production, on endothelial-surface heparan sulfate. Addition of LNA to porcine aortic endothelial cells reduced 125I-labeled antithrombin III binding to the cell surface heparan sulfate in a dose- and time-dependent fashion. Significant inhibition was observed with 1 mM LNA, and the maximal suppression (-50% of control) occurred at 10 mM LNA after 12 h. L-NAME (1 mM) and L-NMMA (1 mM) also significantly inhibited the antithrombin III binding. The iron chelator desferrioxamine significantly prevented the reduction of antithrombin III binding to LNA-treated cells. We further investigated the effect of L-NAME on intracellular oxidative stress of endothelial cells using a hydroperoxide-sensitive fluorochrome, carboxy-dichloro-dihydrofluorescein diacetate bisacetoxymethyl ester probe, and revealed that inhibition of NO synthesis by L-NAME led to a marked increase in intracellular oxidative stress. These results demonstrated that the prolonged inhibition of NO synthesis in porcine aortic endothelial cells decreases the expression of anticoagulant heparan sulfate on endothelial cells through the increase in intracellular oxidative stress, perhaps comprising another mechanism by which NO affects the coagulation system in the vasculature.

Animals↗

[Multidisciplinary approach to an elderly patient with severe congestive heart failure].

A 77-year-old woman with severe valvular heart disease and chronic renal failure was admitted to hospital for control of her heart condition and to improve her ability to perform activities of daily living. In the past 2 years, she had been admitted to hospital four times due to severe congestive heart failure, and she was bedridden because of muscle weakness. A multidisciplinary approach was taken. A cardiologist reassessed her medications and determined an exercise level in co-operation with a physical therapist. After 40 days of rehabilitation, the patient was able to walk 200 m without the help of a cane. With an increase in the exercise level, her cardiothoracic ratio increased from 68 to 74%. The furosemid was then increased from 40 to 60 mg per day and 20 mg of denopamine was added, which resulted in a decrease of the cardiothoracic ratio to 66%. Dietary assessment revealed her usual salt intake was more than 10 g per day, and the dietitian advised the patient that her daily salt intake should be lower than 7 g and water intake less than 800 ml per day. Consultations with social-service personnel made revealed problems in her family and living environment, and she was advised of available social services. For good compliance, the patient had her medication explained by a pharmacist. Assessment of activities of her daily living and intensive education about congestive heart failure were performed by the nurse in charge. After discharge, a nurse team visited her home every two weeks and watched for signs of heart failure. This comprehensive intervention prevented an exacerbation of heart failure and readmission for nine months.

Aged↗

C-reactive protein as a predictor of cardiac rupture after acute myocardial infarction.

Although cardiac rupture is the second most common cause of death after ventricular failure in acute myocardial infarction, no diagnosis has ever been made before an episode of clinical compromise, and no significant predictive factors have been described. This study was designed to determine whether high serum C-reactive protein (CRP) levels could predict the incidence of subacute cardiac rupture after acute myocardial infarction. Nine consecutive patients with cardiac rupture were compared retrospectively with 28 consecutive control patients without rupture after acute myocardial infarction. In the rupture group, peak serum CRP levels increased rapidly and markedly after infarction, reaching more than 20 mg/dl on day 2, and persisted at high levels compared with those in the control group. However, the time course and levels of serum creatine phosphokinase were not significantly different between the two groups. High serum CRP levels ( > 20 mg/dl) had a high diagnostic sensitivity (89%) and specificity (96%) for cardiac rupture. Patients with persistently high serum CRP levels, particularly above 20 mg/dl, might have high probability of occurrence of sub-acute cardiac rupture after acute myocardial infarction.

Aged↗

Relationship between severity of mitral regurgitation and prognosis of mitral valve prolapse: echocardiographic follow-up study.

We investigated the relation between the severity of mitral regurgitation and the development of complications and cardiac events by using two-dimensional and color Doppler echocardiography in 229 consecutive patients with mitral valve prolapse. The frequency of moderate and severe mitral regurgitation was significantly higher in patients with a prolapsed posterior leaflet (61%) than in patients with a prolapsed anterior leaflet (25%), and the older the patient, the greater the severity of mitral regurgitation. The occurrence of complications, such as atrial fibrillation, congestive heart failure, and chordal rupture, was significantly greater in prolapsed posterior leaflet cases than in prolapsed anterior leaflet cases, and the occurrence was closely associated with the degree of severity of mitral regurgitation. Multiple logistic regression analysis showed that the severity of mitral regurgitation is a strong prognostic indicator for developing complications. Furthermore in a subgroup of 49 patients tracked for a mean of 4.8 years, the new development of complications was significantly higher in patients who showed a progression in the severity of mitral regurgitation (52%) that in patients without progression in severity (8%). The initial severity of mitral regurgitation was related to the occurrence of cardiac events (mitral valve replacement, infective endocarditis, cerebral embolism and death). The data indicated that the progression of mitral regurgitation is closely associated with the development of complications and cardiac events and suggest that the severity of mitral regurgitation is an important prognostic indicator for the development of complications and cardiac events in patients with mitral valve prolapse.

Adolescent↗

Power spectral analysis of spontaneous blood pressure and heart rate variability in elderly hypertensives.

To examine the influence of hypertension on cardiovascular variability in elderly subjects, we measured spontaneous beat-to-beat blood pressure (BPV) and heart rate variability (HRV) in elderly subjects with or without hypertension at rest and during tilting. The study group consisted of 23 community-dwelling, male elderly subjects (aged 62-75 years) and was divided into two groups, i.e., a hypertensive group (HT group; n = 11) and normotensive group (NT group; n = 12). According to the modeling and decomposing algorithm of an autoregressive process, we estimated the component power of low-frequency (LF; 0.03-0.15 Hz) and high-frequency components (HF; respiratory frequency) of BPV and HRV by power spectral analysis. We also measured plasma norepinephrine (PNE) levels in the two groups at rest and during tilting. In the HT group, we found that the amplitude of LF-BPV was greater (p < 0.05) and its relative change by postural tilting was smaller (p < 0.05) than those in the NT group. We found no significant difference in the amplitude of LF-HRV and HF-HRV between the two groups, and found no significant response of the amplitude of LF-HRV and HF-HRV to postural tilting. We also found no difference in PNE level between the two groups at rest or during tilting. These results suggest that the regulatory function of sympathetic vasomotor activity assessed by power spectral analysis of BPV is altered in hypertensive elderly subjects, although the influence of hypertension on the autonomic control of the heart is less dominant in the elderly.

Aged↗

Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study).

An elevated serum level of lipoprotein(a) (Lp[a]) may be an independent risk factor for atherosclerotic disease, but the relation of Lp(a) to aortic valve (AV) sclerosis has not been determined. We measured serum concentrations of Lp(a) and investigated their relation to the presence of echocardiographic AV sclerosis in residents of a rural village in Japan. We measured serum Lp(a) levels in 347 men and 437 women aged 35 to 90 years (mean +/- SD: 62 +/- 11 years) who participated in mass screening examinations in Wara village, Gifu, Japan. AV sclerosis was assessed by long- and short-axis 2-dimensional echocardiographic views and continuous-wave Doppler echocardiography. AV sclerosis was graded as follows: 0 = normal AV; 1 = increased echo density; 2 = thickening or calcific deposits > or = 3 mm; and 3 = same as 2 with mildly restricted motion (pressure gradient < 16 mm Hg). Lp(a) levels ranged from < 1 mg/dl to 153 mg/dl. The 25th, 50th, and 75th percentile values were 7, 16, and 28 mg/dl, respectively. Lp(a) levels were significantly higher in women than in men (p < 0.01), and did not increase significantly with age. The prevalence of AV sclerosis (grades 2 and 3) increased significantly with age (p < 0.001). AV sclerosis was present in 65 (36.1%) of 180 subjects with Lp(a) levels > or = 30 mg/dl and in 77 (12.7%) of 604 subjects with Lp(a) levels < 30 mg/dl (p < 0.001). There were no significant differences in the prevalence of AV sclerosis in terms of sex, blood pressure, or levels of total cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood sugar. We conclude that increased serum levels of Lp(a), as well as aging, are closely related to AV sclerosis.

Adult↗

[Right-sided infectious endocarditis due to methicillin-resistant Staphylococcus aureus resulting in ruptured abscess of the ventricular septum and sinus of Valsalva].

A 24-year-old woman presented with right-sided infectious endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA). This is the first report of right-sided infectious endocarditis caused by MRSA in Japan. The patient was admitted to the Jichi Medical School Hospital because of fever of unknown origin and disturbance of consciousness. Several months before, she had discontinued treatment for hyperthyroidism. Antibiotics effective against MRSA, vancomycin and flomoxef, were given intravenously, but a new heart murmur was detected. Echocardiographic study revealed vegetations attached to the tricuspid valve and abscess formation on the ventricular septum. The vancomycin dosage was increased and arbekacin sulfate was also given from the sixth hospital day. However, these antibiotics had very little effect and the abscess rapidly increased in size. Color flow mapping finally demonstrated intracardiac shunt flow through the ruptured abscess of the ventricular septum and sinus of Valsalva. She died suddenly, probably from heart failure. The prognosis of infectious endocarditis due to MRSA is poor and drug therapy often fails. Thus, surgery should be considered in the early stage.

Abscess↗

Thrombin generation as an acute effect of cigarette smoking.

The effects of acute smoking on hemostatic functions were investigated in healthy young volunteers. Immediately after the volunteers smoked, a significant increase in blood pressure and heart rate was accompanied by a rise in plasma epinephrine. Fibrinopeptide A and thrombin-antithrombin III complex as markers of thrombin generation in vivo were significantly increased after smoking. The increase in thrombin-antithrombin III complex was significantly correlated with that of plasma epinephrine. Both antigen and activity of tissue plasminogen activator and plasmin-inhibitor complex as markers of fibrinolytic activity in vivo were markedly increased after smoking, whereas D-dimer, plasminogen activator inhibitor antigen, fibrinogen, and both beta-thromboglobulin and platelet factor 4 as markers of platelet activation in vivo were not changed. No effects were observed after sham smoking under exactly identical conditions in the same subjects. Thus thrombin generation was observed as acute hemostatic effects of smoking. Enhanced fibrinolytic response may counteract an increased procoagulant activity. Patients with vascular disease might be more susceptible to a state of disequilibrium in favor of coagulation, which may partly explain a mechanism by which cigarette smoking leads to cardiovascular morbidity and mortality.

Adult↗

Nitric oxide synthesis in rat cardiac myocytes and fibroblasts.

We investigated nitric oxide (NO) synthase activity in cultured neonatal rat cardiac myocytes and fibroblasts upon treatment with interleukin 1 beta (IL-1 beta) and lipopolysaccharide (LPS). Incubation of cardiac myocytes for 24 h with IL-1 beta or LPS caused a significant increase in NO and cGMP production. Simultaneous incubation of IL-1 beta with NG-monomethyl-L-arginine or transforming growth factor beta (TGF-beta) completely inhibited the IL-1 beta-induced NO and cGMP production in cardiac myocytes. In contrast, incubation of cardiac fibroblasts for 24 h with IL-1 beta or LPS showed no significant effect on NO or cGMP production. Addition of IL-1 beta decreased the beating rate of cardiac myocytes, but TGF-beta overcame that inhibition. These observations suggest the presence of iNOS in cardiac myocytes, which is an important regulator of contractile function of the heart.

Amino Acid Oxidoreductases↗

[Characteristics of blood pressure regulating endocrinological factors in elderly essential hypertensives].

Plasma renin activity (PRA) was lower in elderly normotensive subjects and essential hypertensives (EHT), and a significant negative correlation was found between PRA and age in both groups. In EHT, the proportion of the low renin group to total EHT increased with aging. There was a significantly positive correlation between plasma norepinephrine (PNE) and age in NT, but not in EHT. The mean value of PNE in young subjects was significantly higher in EHT than in NT, but not in the middle-aged and elderly groups, suggesting the important role of PNE in young EHT. Power spectral analysis revealed a significant reduction of both sympathetic and parasympathetic activity with aging in NT and EHT, indicating much caution may be required if sympathetic nerve activity is evaluated only by PNE levels in elderly EHT. The expanded plasma volume was another characteristic in elderly EHT, and suppressed activity of renal kallikrein-kinin, prostaglandin and dopamine may be involved with its mechanisms. Regarding insulin sensitivity in elderly EHT, it was shown that 1) the reduction of insulin sensitivity plays some role in age related acceleration of hypertension and glucose intolerance, 2) selective insulin resistance with respect to glucose metabolism already exists at lower ages in EHT, and 3) both Na retention and pressor system activation via insulin action might be a cause of blood pressure elevation in EHT.

Adult↗

Pathophysiology and end-organ damage in elderly hypertensives.

PATHOPHYSIOLOGY OF HYPERTENSION: Blood pressure increases with advancing age in most developed countries. The pathophysiology of elderly hypertension is characterized by changes in the structure and function of the cardiovascular system. Changes in arterial structure lead to a decrease in aortic compliance, which augments the aortic pressure component generated by the wave reflection mechanism. The age-related increase in the reflected-wave component of arterial pressure may contribute, at least in part, to the age-related rise in systolic blood pressure. Disproportionately elevated systolic blood pressure in the elderly may account for the progressive increase in left ventricular mass with advancing age. In addition to the changes in vascular and cardiac structures, the haemodynamic function of elderly hypertensives is characterized by increased peripheral resistance as well as reduced cardiac output, renal blood flow and intravascular volume. In contrast to younger hypertensives, the sympathetic and renin-angiotensin systems may not be major factors in the genesis of high peripheral resistance in this patient group. END-ORGAN DAMAGE: The most important end-organ damage in elderly hypertensives is left ventricular hypertrophy with or without coronary heart disease, cerebrovascular disease or renal impairment. Furthermore, this end-organ damage is frequently asymptomatic (silent). The prevalence of silent cerebrovascular disease in particular is surprisingly high in this elderly population. Asymptomatic cerebrovascular disease has been shown to be associated with various cardiovascular risk factors, and depressed neurobehavioural function. Diurnal blood pressure variations appear to be related to end-organ damage. The presence of occult end-organ damage and co-existing diseases common in elderly hypertensives has important clinical implications in the management of this disorder.

Aged↗

Altered levels of erythrocyte calcium-binding proteins in essential hypertensives with genetic predisposition: correlation with ambulatory blood pressure.

OBJECTIVE: To examine whether changes in calcium-binding proteins, one of the components of the calcium ion handling mechanism, occur in humans with essential hypertension. DESIGN: We measured the levels of cytosolic calcium-binding proteins purified from human erythrocytes using a felodipine fluorescence assay, and examined the correlation between this parameter and the ambulatory blood pressure (ABP). We divided 127 subjects into four age-matched groups according to their mean ABP levels and whether they had a family history of both hypertension and stroke [group A hypertensives with a positive family history (n = 30), group B hypertensives with no family history (n = 31), group C normotensives with a family history (n = 31) and group D normotensives with no family history (n = 35) of hypertension and stroke]. RESULTS: The erythrocyte cytosolic level of calcium-binding proteins in group A was significantly lower than that in group B, as was that in group C compared with group D. There was no significant correlation between the erythrocyte level of calcium-binding proteins and casual blood pressure values in any group. However, in group A significant negative correlations between the erythrocyte level of calcium-binding proteins and systolic and mean ABP were observed (r = -0.34, P < 0.05 and r = -0.39, P < 0.05, respectively). No significant correlations between the ABP and erythrocyte levels of calcium-binding proteins were observed in the other groups. When each group was subdivided according to sex, there were significant negative correlations between the erythrocyte level of calcium-binding proteins and the systolic and mean ABP in the males of groups A and C, but no correlations were found in any of the female subgroups or the males of groups B and D. Reducing the blood pressure by antihypertensive drug therapy did not affect the erythrocyte calcium-binding proteins level in 13 patients from groups A and B. Analysis using anion-exchange fast-performance liquid chromatography on a Mono-Q column and sodium dodecyl sulphate-polyacrylamide gel electrophoresis revealed that the calcium-binding proteins in human erythrocytes, the levels of which were low in group A, formed a single protein band with a molecular weight of 17,000, which was assumed to be a calmodulin. CONCLUSIONS: These results suggest that there are subgroups of hypertensive patients with low erythrocyte cytosolic levels of calcium-binding proteins, which are genetically determined. Furthermore, our data suggest that the erythrocyte level of calcium-binding proteins and ABP in male subjects with hypertension and normotensives with a genetic predisposition are correlated strongly, whereas no such correlation was observed in any female subgroup. This indicates that the regulatory mechanism or mechanisms involved in the control of blood pressure in men and women may be different.

Aging↗

[Heparan sulfate proteoglycan of endothelial cells: homocysteine suppresses anticoagulant active heparan sulfate in cultured endothelial cells].

The endothelial surface plays an important role in the pathogenesis of atherosclerosis and the regulation of coagulation. It has become increasingly clear that while perturbed endothelial cells generate procoagulant activity, under normal conditions they possess multiple antithrombotic and anticoagulant mechanisms, including generation of prostacyclin and plasminogen activators and synthesis of thrombomodulin as a cell surface cofactor for thrombin-catalyzed activation of protein C. In addition, anticoagulantly active heparan sulfate proteoglycans, including heparin-like molecules are apparently present on the vascular surface. Previous studies showed that homocysteine, a thromboatherogenic and atherogenic agent, inhibits an endothelial thrombomodulin-protein C anticoagulant pathway. We examined whether homocysteine might affect another endothelial anticoagulant mechanism; i.e., heparin-like glycosaminoglycan-antithrombin III interactions. Incubations of cultured endothelial cells with homocysteine reduced the amount of antithrombin III bound to the cell surface in a dose- and time-dependent fashion. In contrast with a marked reduction in the maximal antithrombin III binding capacity, the radioactivity of [35S] sulfate incorporated into heparan sulfate on the cell surface was minimally reduced. Although neither net negative charge nor proportion in total glycosaminoglycans of cell surface heparan sulfate was altered by homocysteine treatment, a substantial reduction in antithrombin III binding capacity of heparan sulfate isolated from homocysteine-treated endothelial cells was found using both affinity chromatography and dot blot assay techniques. The antithrombin III binding activity of endothelial cells decreased after preincubation with homocysteine, cysteine, or 2-mercaptoethanol, containing a sulfhydryl group; no reduction in binding activity was observed after preincubation with methionine, alanine.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗

Alterations in cytosolic calcium-binding proteins that increase felodipine fluorescence in spontaneously hypertensive rats.

OBJECTIVE: To clarify the role of calcium-binding proteins (CaBP) in hypertension. DESIGN: CaBP from several organs of spontaneously hypertensive rats (SHR) and age-matched Wistar-Kyoto (WKY) rats were purified and their characteristics compared between the two strains. The CaBP were purified by applying the soluble cytosolic fractions from mesenteric vessels, heart, kidney and brain of 4- and 10-week-old SHR and WKY rats to a phenyl-Sepharose column. Felodipine binding to the purified CaBP was then measured. RESULTS: The fluorescence intensity of felodipine increased in a calcium-dependent manner when it bound to CaBP. The pK 0.5 Ca2+ values derived from the calcium ion-felodipine fluorescence curves for each CaBP preparation from organs of the two strains were similar, indicating that the calcium sensitivities of the CaBP to the felodipine binding process are similar in SHR and WKY rats. In 10-week-old SHR the mean levels of felodipine-bound CaBP in heart, brain and kidney were significantly altered compared with those in WKY rats. No such alterations were observed in heart, kidney and brain from 4-week-old SHR and WKY rats. Conversely, the mean levels of felodipine-bound CaBP in mesenteric vessels from 4- and 10-week-old SHR were reduced significantly compared with those of age-matched WKY rats. CONCLUSIONS: These results suggest that the levels of cytosolic felodipine-bound CaBP from heart, kidney and brain are altered in response to elevated blood pressure, and that reduced levels of felodipine-bound CaBP in the mesenteric vessels of SHR might be a primary characteristic of this rat strain.

Animals↗

Accuracy of a continuous blood pressure monitor based on arterial tonometry.

A validation study of the continuous noninvasive tonometric blood pressure monitor called JENTOW was performed in 20 normotensive subjects and 10 hypertensive patients. Tonometric and intra-arterial blood pressures were simultaneously recorded at supine rest and during a Valsalva maneuver and tilting test. The results of the strict evaluation of the instrument's capacity for reproducing intra-arterial blood pressure were as follows: 1) The overall frequency response of the transcutaneous blood pressure-monitoring system based on arterial tonometry was flat, with negligible delay to intra-arterial blood pressure in the range of 0-5 Hz. 2) The largest discrepancy between intra-arterial and tonometric pressure waveforms was found at the early systolic phase; except for this phase, the tonometric waveform was almost equal to the intra-arterial waveform. 3) The beat-to-beat variability of tonometric pressure corresponded to that of intra-arterial pressure almost perfectly in the physiologically significant frequency range of 0-0.5 Hz. 4) During resting conditions, the averages of the systolic and diastolic values measured tonometrically corresponded well to those measured intra-arterially. 5) The changes in the between-method discrepancy of blood pressure values during the Valsalva maneuver were statistically significant but small (< 5 mm Hg). 6) No significant effect of postural tilting was found on the between-method discrepancy. We conclude that this method is clinically acceptable and reliable except for its limited capacity for recording the higher frequency intra-arterial waveform and for responding to the relatively rapid and large transient changes in blood pressure.

Adult↗

Homocysteine, a thrombogenic agent, suppresses anticoagulant heparan sulfate expression in cultured porcine aortic endothelial cells.

Previous studies showed that homocysteine, a thrombo-atherogenic and atherogenic agent, inhibits an endothelial thrombomodulin-protein C anticoagulant pathway. We examined whether homocysteine might affect another endothelial anticoagulant mechanism; i.e., heparin-like glycosaminoglycan-antithrombin III interactions. Incubations of porcine aortic endothelial cell cultures with homocysteine reduced the amount of antithrombin III bound to the cell surface in a dose- and time-dependent fashion. The inhibitory effect was observed at a homocysteine concentration as low as 0.1 mM, and the maximal suppression occurred at 1 mM of homocysteine after 24 h. In contrast with a marked reduction in the maximal antithrombin III binding capacity (approximately 30% of control), the radioactivity of [35S]sulfate incorporated into heparan sulfate on the cell surface was minimally (< 15%) reduced. The cells remained viable after homocysteine treatment. Although neither net negative charge nor proportion in total glycosaminoglycans of cell surface heparan sulfate was altered by homocysteine treatment, a substantial reduction in antithrombin III binding capacity of heparan sulfate isolated from homocysteine-treated endothelial cells was found using both affinity chromatography and dot blot assay techniques. The antithrombin III binding activity of endothelial cells decreased after preincubation with 1 mM homocysteine, cysteine, or 2-mercaptoethanol; no reduction in binding activity was observed after preincubation with the same concentration of methionine, alanine, or valine. This sulfhydryl effect may be caused by generation of hydrogen peroxide, as incubation of catalase, but not superoxide dismutase, with homocysteine-treated endothelial cells prevented this reduction, whereas copper augmented the inhibitory effects of the metabolite. Thus, our data suggest that the inhibited expression of anticoagulant heparan sulfate may contribute to the thrombogenic property resulting from the homocysteine-induced endothelial cell perturbation, mediated by generation of hydrogen peroxide through alteration of the redox potential.

Animals↗

[Hyperbilirubinemia associated with sepsis in the elderly].

In order to elucidate the frequency of hyperbilirubinemia associated with sepsis in the elderly, as well as in clinical and histological characteristics, a total of 117 autopsy cases with sepsis were analyzed retrospectively. Based on the clinico-pathological findings, 48 cases with primary hepato-biliary, cardiac, hematological and shock complications, were excluded because these disorders were thought to affect liver function tests. Four cases out of the remaining 69 cases, 5.8% of the total, showed hyperbilirubinemia above 2 mg/dl (average 4.1 mg/dl), which was thought to be associated with sepsis itself. In these 4 cases, disproportionately high levels of blood total bilirubin were characteristic compared to changes of GOT, GPT, LDH, ALP and gamma-GTP levels. Blood culture of these 4 cases revealed Gram-negative organisms in 3 cases and Gram-positive in 1 case. Histological findings of the liver included cholestasis, Kupffer cell hyperplasia and cell infiltration in the sinusoid and portal areas, however these findings were mild and nonspecific. It is important to recognize the presence of hyperbilirubinemia associated with sepsis in order to properly treat febrile elderly patients with hyperbilirubinemia.

Aged↗